Take action to prevent injuries and psychological harm that may result from workplace
violence. Eliminate the situation that may result in violence wherever practicable. If elimination is not practicable, isolate or minimise the hazard and protect the employee. Ways to do this include, but are not limited to, substituting a hazardous procedure with a less hazardous one, reorganising the work environment, and providing protective equipment and emergency support.
1. Eliminate the hazard.
Change the system of work to eliminate the hazard and contributing factors. Sometimes the exact reason or trigger for workplace violence can be identified and work procedures altered accordingly, for example, eliminating the need to openly carry large amounts of cash, or removing or eliminating something that is known to contribute to hostile behaviour. However, in the home care setting, and in the community mental health setting in particular, factors contributing to violence are likely to be multiple and/or difficult to predict and elimination may not be possible.
Sometimes, refusal to accept a client for care or withdrawal of service may the only way to eliminate the risk of violence in a given case.
2. Where the hazard cannot be eliminated, isolate the hazard.
Isolating the hazard by separation with space, time or barriers might include:
• removing potential violent weapons such as paper spikes, scissors or knives in areas where they present an opportunity for violence to worsen and their removal is practicable; • job rotation may be used to reduce the amount of time employees are in stressful work
situations, especially when they are new to the job;
• rostering can also used as a method to reduce the period of exposure to aggressive situations.
3. Where the hazard cannot be eliminated or isolated, minimise the hazard and protect employees.
• introduce team care or buddying where practicable in situations where the risk of violent behaviour is high or the situation is unknown, such as a first visit;
• ensure every effort is made to match the needs of the client with the skills and experience of the caregiver;
• ensure an escape route is always planned and keep it open — always aim to avoid dead ends where you may be unable to retreat to a safer place when necessary.
• ensure new employees are not required to work without full supervision until they have the competencies to do so and buddy with more experienced staff when needed;
• ensure ongoing analysis of reported incidents to assess any need for additional training or information;
• proactively monitor the employees’ stress and fatigue levels (refer to the OSH guide Stress and Fatigue: Their Impact on Health and Safety in the Workplace).
4. Set up effective systems for transfer of information.
Where employees interact with people who may be violent, the transfer of information from one care provider to another will allow each person to be prepared for a potentially violent incident. The disclosure of health information needs to be in accordance with the Privacy Act and the Health Information Privacy Code.
Those who are providing care need to have access to information relevant to their ability to provide and maintain safe care of the client. Policies need to be in place to determine who has access to records so that privacy of health information is maintained. (See Section Two for more information on transfer of information.) Health professionals need to ask themselves the questions:
• Who will get the information? • Why will they get the information? • Why is that necessary?
• What is the likely impact on privacy and confidentiality?
5. Set up effective communication systems to be used in an emergency. • Have relevant numbers available.
• Have a means of communicating. • Have a means of indicating alarm.
• Ensure all employees know their role in the event of an emergency.
6. Provide training and supervision.
Section 13 of the HSE Act requires that employers specifically train and supervise employees. Training needs to be appropriate to the client group, and will need to take into account the level of care provided and the existing training and knowledge base of the participant. Training should be evidence-based and in accordance with current accepted best practice and related health and disability sector standards.
Two types of training in workplace violence are needed: general training and task-specific training.
General Training
When should training in workplace violence take place? (a) during induction training; and
(b) as part of a regular violence prevention programme.
The training should meet national standards where they exist. In the absence of such standards, individual or groups of providers may develop such standards.
Who should attend?
Everyone involved in managing and providing care where workplace violence has been identified as an actual or potential hazard.
The level of training provided should be comparable to the risk involved. Any training should focus on the specific problems identified in the hazard assessment process.
Training should aim to:
• equip employers and employees with the ability to assess the level of risk in a particular situation and choose the most appropriate procedure, including when to withdraw from a situation to seek assistance; and
• equip employees to make reasonable decisions in the circumstances and to balance the need for actions needed to maintain their own safety and the safety of others who may be in their care.
Depending on the degree of risk, participants should have an understanding of some or all of the following:
• the role and responsibilities of the employer, employees and others in the prevention and management of workplace violence;
• the hazard management approach to workplace violence;
• consultation which should take place between employer and employees in order to identify the potential for workplace violence, and to assess and control risks;
• types of workplace violence and a range of influencing factors in home-based health care settings;
• application of relevant prevention and control strategies;
• safety procedures that are in place to reduce the risk of workplace violence and consequences if they are not followed;
• emergency procedures. Task-Specific Training
When should task-specific training take place? (a) during induction to the task;
(b) as part of refresher training; and
(c) when work tasks are about to be changed or introduced.
Instructions need to be specific to the work situation, appropriate to the client group, and according to the level of skill and responsibility expected from the worker.
Training should aim to:
• inform employees of their role and responsibilities;
• improve the employees’ ability to communicate, defuse and manage situations where there is a potential for violence;
• provide guidance on how to prevent the occurrence of harm to self or others. Training components may include some or all of the following, as relevant:
• verbal and nonverbal communication techniques;
• responding to challenging behaviour, aggression or violence; • skills in defusing hostile situations;
• de-escalation techniques;
• safe management of restraint techniques where appropriate; • how to access help in an emergency.
Training in self-defence is an important element of any violence prevention programme, however, it needs to be presented as a last line of defence, suitable when all other measures are attempted but fail to contain the violent behaviour.
Supervision should be provided on the job to reinforce the new skills learned in training and to ensure they are put in place. It is not sufficient to train employees in how to behave if a violent incident occurs and hope the employees apply it when they return to their workplaces.
7. Establish clear policies.
Create and disseminate a clear policy of non-tolerance for workplace violence, verbal and nonverbal threats, and related situations. Managers, supervisors, employees, clients and visitors must be advised of this policy.
The policy may include a commitment to:
• maintain a supportive environment that places as much importance on employee safety and health as on serving the patient or client;
• identify risk of violence or aggression and take all practicable steps to prevent them from occurring;
• encourage employees to promptly report incidents and suggest ways to reduce or eliminate risks;
• ensure that there are adequate resources available to prevent incidents from occurring; • require records of incidents to assess risks and to measure progress;
• support any employee who reports or experiences workplace violence and ensure that no harm comes to them as a result of reporting incidents;
• assign responsibility and authority to individuals or teams with appropriate training and skills and experience;
• support and implement appropriate recommendations from health and safety committees and accident/incident investigations.
8. Develop and implement a violence prevention programme.
A violence prevention programme is a written programme for workplace safety and security, incorporated into the organisation’s overall health and safety programme.
The programme should have clear goals and objectives to prevent workplace violence, suitable for the size and complexity of the organisation, and adaptable to specific situations in the working environment. Training of employees will be a key part of the programme. The programme should also outline support for affected employees and a programme of rehabilitation to facilitate recovery. This includes counselling and debriefing for employees experiencing assaults and other violent incidents.
The team or individuals responsible for the programme should be provided with the
opportunity to develop expertise on workplace violence prevention in home-based health care. The programme should allow employee involvement in the design, implementation and evaluation of the programme.